Centre for Modern Indian Studies & Department of Economics, University of Göttingen, Waldweg 26, 37073, Göttingen, Germany.
BMC Health Serv Res. 2021 Dec 19;21(1):1356. doi: 10.1186/s12913-021-07333-z.
This study looks at the factors that can shape patients' choice of healthcare providers. Understanding this process can help with making high quality healthcare more accessible for all. We focus on distance, patient's health status, (perceived) quality of healthcare facility, and referrals to investigate how these factors compete in shaping patients' choice of hospitals.
This study was carried out in Managua, the capital of Nicaragua. Utilizing an exit-survey, patients were interviewed across five public hospitals in 2017 and then six in 2019 when a new highly-equipped hospital was added to the system. We used a multinomial logit model to investigate patients' preference of a specific hospital over the rest within each wave.
Our results show that being referred to a hospital is the strongest predictor and in some cases, it can increase the relative risk ratio of choosing a facility by a factor of 49 (p < 0.01; 95% CI: 27.39-87.17). For the remaining factors, the hierarchy of importance was less clear-cut yet all these factors remained significantly important at various levels.
Overall, our results highlight the importance of referral systems in making quality healthcare more equitable. Moreover, with distance also being a key predictor and in the absence of an organized referral system, those with low-income would either be further deprived by having to settle with locally available healthcare (regardless of its quality) or face high amounts of out-of-pocket expenditure when seeking help from the private sector.
本研究着眼于影响患者选择医疗服务提供者的因素。了解这一过程有助于使所有人都能获得高质量的医疗服务。我们专注于距离、患者的健康状况、（感知到的）医疗设施质量和转诊，以调查这些因素如何在塑造患者对医院的选择方面相互竞争。
本研究在尼加拉瓜首都马那瓜进行。利用出院调查，于 2017 年在五家公立医院对患者进行了访谈，2019 年又对六家医院进行了访谈，当时系统中新增了一家设备齐全的新医院。我们使用多项逻辑回归模型来调查患者在每一波次中对特定医院相对于其他医院的偏好。
我们的结果表明，转诊是最强的预测因素，在某些情况下，它可以将选择医疗机构的相对风险比提高 49 倍（p<0.01；95%CI：27.39-87.17）。对于其余因素，重要性的层次结构不太明确，但所有这些因素在不同层面仍然具有重要意义。
总体而言，我们的结果强调了转诊系统在使高质量医疗服务更加公平方面的重要性。此外，由于距离也是一个关键的预测因素，而且没有组织良好的转诊系统，低收入者要么不得不满足于当地现有的医疗服务（无论其质量如何），要么在寻求私营部门帮助时面临高额自付费用。
